My dad has been diagnosed with NSCLC adenocarcinoma that is EGFR 19 deletion and ALK positive. I understand that this is an extremely rare case to have 2 mutations and I am wondering if this were the case, whether we should be treating for these 2 mutations concurrently? He is currently taking Iressa and our onco has suggested to continue with Iressa for the time being.

I am feeling a little concern about not treating for ALK as well, in fear that just taking Iressa would only treat the EGFR mutation which may then allow the ALK to continue to progress.

Welcome to GRACE. I’m sorry to hear of your dad’s diagnosis, but it’s positive news that he has actionable mutations that can be attacked with targeted therapies.

GRACE’s Dr. Pennell had this to say about having both mutations:

“generally we think of the “driver mutations” (that drive the cancer to grow) such as EGFR mutations, KRAS mutations, or ALK translocations as being mutually exclusive. In some rare cases they are found together, but in that setting typically only one is dominant and confers sensitivity to a drug like Tarceva or crizotinib.” – http://cancergrace.org/forums/index.php?topic=9730.msg77205#msg77205

So it may be that significantly more cells showed the EGFR mutation than the ALK rearrangement, which would explain his doctor’s preference for the EGFR inhibitor. Even if that’s not the case, typically the EGFR and ALK inhibitors are not combined, and since he’s likely to be closely monitored with follow-up scans and clinical examinations, if the EGFR inhibitor does not seem to be working and there is noticeable, significant progression, he can switch to an ALK inhibitor. Many patients and caregivers quite understandably have a desire to discover the smallest amount of progression as soon as possible and then switch treatments, but that is usually neither necessary nor does a rapid change in therapy tend to provide the best results.

Good luck with Iressa, and please let us know how he’s doing, and be sure to post any other questions that arise.